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Reducing antibiotic prescriptions for respiratory tract infections in family practice: results of a multifaceted peer-group-based intervention.

Vervloet, M., Meulepas, M.A., Cals, J.W.J., Eimers, M., Hoek, L.S. van der, Dijk, L. van. Reducing antibiotic prescriptions for respiratory tract infections in family practice: results of a multifaceted peer-group-based intervention. NPJ Primary Care Respiratory Medicine: 2016, 26(15083)
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Irrational antibiotic use for respiratory tract infections (RTI) is a major driver of bacterial resistance. The aim of this study was to evaluate the effect of a multifaceted peer-group based intervention aiming to reduce RTI-related antibiotic prescriptions in family practice. This was a cluster randomized controlled trial with pre- and follow-up measurement. The intervention was implemented through PharmacoTherapy Audit Meetings (PTAM) in which family physicians (FPs) and pharmacists collaborate. Four PTAM groups received the intervention consisting of:
(1) FP communication skills training, including communication about delayed prescribing;
(2) implementation of antibiotic prescribing agreements in FPs’ Electronic Prescribing Systems;
(3) quarterly feedback figures for FPs. Four other PTAM groups were matched controls.

Primary outcome measure was the number of RTI-related antibiotic prescriptions after the intervention, assessed with multilevel linear regression analyses. Total number and number of prescriptions stratified by age (under/over 12 years) were analysed. At baseline, the average total number of RTI-related antibiotic prescriptions per 1,000 patients was 207.9 and 176.7 in the intervention and control PTAM groups, respectively. At follow-up, FPs in both the intervention and control groups prescribed significantly less antibiotics. For adolescents and adults, the drop in number of antibiotic prescription was significantly larger in the intervention groups (−27.8 per 1,000 patients) than the control groups (−7.2 per 1,000 patients; P<0.05). This multifaceted peer-group-based intervention was effective in reducing the number of RTI-related antibiotic prescriptions for adolescents and adults. To affect antibiotic prescribing in children other methods are needed. (aut. ref.)